Re: Progressive services?

[Guest guest]

ah...then you are misunderstanding the meaning of the platitude by taking

it at apparent face value.

One of the things repeatedly emphasized in ACLS and ATLS (as much as I

despise the merit badge approach to medical education) is that if the patient

is NOT getting better, go back to basics and reevaluate your patients from

the ABCs.

These are the basics that save paramedics (and doctors and nurses)-

remembering and applying basic principles to every patient who is not responding

as expected.

Things like appropriate air movement as the gold standard of ventilation;

that leaks need to be plugged before fluids are poured in, so " don't pop

the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis does

not mean pain/panic relief; a very gravid patient should not be laying flat

on her back; and that the best antibiotic is often the hand washing and hand

sanitizing done before touching the patient (including sanitizing your

stethescope).

ck

In a message dated 4/3/2010 04:18:54 Central Daylight Time,

rob.davis@... writes:

If your EMTs are saving your paramedics, your paramedics suck, and your

system needs some serious work.

[Guest guest]

and the reason it has been bastardized is that 'the basics' are all that

EMT-Basics have to work with...so at least on occasion, the Basic sees the

Forest, while the Medic is stuck in the trees...even in the best of systems.

ck

In a message dated 4/3/2010 05:21:56 Central Daylight Time,

rob.davis@... writes:

Ah! Well now this is something we certainly agree upon. The so-called

" basics " are indeed the foundation of medical practice at all levels. Yes, they

do get overlooked in the heat of the moment, and again, by practitioners

at all levels. In that respect, " the basics " save us all, and hopefully our

patients too. But all too often the concept is bastardised to mean

EMT-Basics, not " the basics " , and that is the point I contend.

Rob

On Saturday, April 3, 2010 04:33, _krin135@..._

(mailto:krin135@...) said:

> ah...then you are misunderstanding the meaning of the platitude by

taking

> it at apparent face value.

>

> One of the things repeatedly emphasized in ACLS and ATLS (as much as I

> despise the merit badge approach to medical education) is that if the

patient

> is NOT getting better, go back to basics and reevaluate your patients

from

> the ABCs.

>

> These are the basics that save paramedics (and doctors and nurses)-

> remembering and applying basic principles to every patient who is not

responding

> as expected.

>

> Things like appropriate air movement as the gold standard of

ventilation;

> that leaks need to be plugged before fluids are poured in, so " don't pop

> the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis

does

> not mean pain/panic relief; a very gravid patient should not be laying

flat

> on her back; and that the best antibiotic is often the hand washing and

hand

> sanitizing done before touching the patient (including sanitizing your

> stethescope)

>

> ck

[Guest guest]

and the reason it has been bastardized is that 'the basics' are all that

EMT-Basics have to work with...so at least on occasion, the Basic sees the

Forest, while the Medic is stuck in the trees...even in the best of systems.

ck

In a message dated 4/3/2010 05:21:56 Central Daylight Time,

rob.davis@... writes:

Ah! Well now this is something we certainly agree upon. The so-called

" basics " are indeed the foundation of medical practice at all levels. Yes, they

do get overlooked in the heat of the moment, and again, by practitioners

at all levels. In that respect, " the basics " save us all, and hopefully our

patients too. But all too often the concept is bastardised to mean

EMT-Basics, not " the basics " , and that is the point I contend.

Rob

On Saturday, April 3, 2010 04:33, _krin135@..._

(mailto:krin135@...) said:

> ah...then you are misunderstanding the meaning of the platitude by

taking

> it at apparent face value.

>

> One of the things repeatedly emphasized in ACLS and ATLS (as much as I

> despise the merit badge approach to medical education) is that if the

patient

> is NOT getting better, go back to basics and reevaluate your patients

from

> the ABCs.

>

> These are the basics that save paramedics (and doctors and nurses)-

> remembering and applying basic principles to every patient who is not

responding

> as expected.

>

> Things like appropriate air movement as the gold standard of

ventilation;

> that leaks need to be plugged before fluids are poured in, so " don't pop

> the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis

does

> not mean pain/panic relief; a very gravid patient should not be laying

flat

> on her back; and that the best antibiotic is often the hand washing and

hand

> sanitizing done before touching the patient (including sanitizing your

> stethescope)

>

> ck

[Guest guest]

and the reason it has been bastardized is that 'the basics' are all that

EMT-Basics have to work with...so at least on occasion, the Basic sees the

Forest, while the Medic is stuck in the trees...even in the best of systems.

ck

In a message dated 4/3/2010 05:21:56 Central Daylight Time,

rob.davis@... writes:

Ah! Well now this is something we certainly agree upon. The so-called

" basics " are indeed the foundation of medical practice at all levels. Yes, they

do get overlooked in the heat of the moment, and again, by practitioners

at all levels. In that respect, " the basics " save us all, and hopefully our

patients too. But all too often the concept is bastardised to mean

EMT-Basics, not " the basics " , and that is the point I contend.

Rob

On Saturday, April 3, 2010 04:33, _krin135@..._

(mailto:krin135@...) said:

> ah...then you are misunderstanding the meaning of the platitude by

taking

> it at apparent face value.

>

> One of the things repeatedly emphasized in ACLS and ATLS (as much as I

> despise the merit badge approach to medical education) is that if the

patient

> is NOT getting better, go back to basics and reevaluate your patients

from

> the ABCs.

>

> These are the basics that save paramedics (and doctors and nurses)-

> remembering and applying basic principles to every patient who is not

responding

> as expected.

>

> Things like appropriate air movement as the gold standard of

ventilation;

> that leaks need to be plugged before fluids are poured in, so " don't pop

> the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis

does

> not mean pain/panic relief; a very gravid patient should not be laying

flat

> on her back; and that the best antibiotic is often the hand washing and

hand

> sanitizing done before touching the patient (including sanitizing your

> stethescope)

>

> ck

[Guest guest]

you might be surprised where you find EMT-Basics even in the best systems:

many military MEDEVAC pilots cross trained in the past as A's or

B's...since that is a significant source of pilots for civilian birds....

additionally, many of the heavy medical transport units (the critical care

units on wheels with hot and cold running residents, etc) use B's as

drivers...

Quite a few Level III and at least some Level II and I trauma units have

their Nurse's Aides trained to the B level...

and good docs, nurses and medics in those kinds of systems will listen when

their B tugs on their sleeve and says, " I'm not sure but I think something

has been missed. "

As a medical student and intern, I learned that there were times where I,

having to stand back and observe, noticed a problem before the rest of the

team did....I soon learned that asking an apparently 'dumb' question, while

occasionally bringing heat from the attending, often resulted in a better

result for the patient, and ultimately got me some jujubees...like the time

the 4th year resident had to go upstairs and write her own off service

notes while the junior resident (me) got to leave a day early for

vacation...the attending had noticed who had actually been doing the work to

keep the

service running.

Ultimately, the EMS system is only as good as the most observant member of

the team working on the patient at the time.

ck

In a message dated 4/3/2010 05:38:28 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 05:30, _krin135@..._

(mailto:krin135@...) said:

> and the reason it has been bastardized is that 'the basics' are all that

> EMT-Basics have to work with...so at least on occasion, the Basic sees

the

> Forest, while the Medic is stuck in the trees...even in the best of

systems.

Except that the " best " systems don't use EMT-Basics.

[Guest guest]

you might be surprised where you find EMT-Basics even in the best systems:

many military MEDEVAC pilots cross trained in the past as A's or

B's...since that is a significant source of pilots for civilian birds....

additionally, many of the heavy medical transport units (the critical care

units on wheels with hot and cold running residents, etc) use B's as

drivers...

Quite a few Level III and at least some Level II and I trauma units have

their Nurse's Aides trained to the B level...

and good docs, nurses and medics in those kinds of systems will listen when

their B tugs on their sleeve and says, " I'm not sure but I think something

has been missed. "

As a medical student and intern, I learned that there were times where I,

having to stand back and observe, noticed a problem before the rest of the

team did....I soon learned that asking an apparently 'dumb' question, while

occasionally bringing heat from the attending, often resulted in a better

result for the patient, and ultimately got me some jujubees...like the time

the 4th year resident had to go upstairs and write her own off service

notes while the junior resident (me) got to leave a day early for

vacation...the attending had noticed who had actually been doing the work to

keep the

service running.

Ultimately, the EMS system is only as good as the most observant member of

the team working on the patient at the time.

ck

In a message dated 4/3/2010 05:38:28 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 05:30, _krin135@..._

(mailto:krin135@...) said:

> and the reason it has been bastardized is that 'the basics' are all that

> EMT-Basics have to work with...so at least on occasion, the Basic sees

the

> Forest, while the Medic is stuck in the trees...even in the best of

systems.

Except that the " best " systems don't use EMT-Basics.

[Guest guest]

you might be surprised where you find EMT-Basics even in the best systems:

many military MEDEVAC pilots cross trained in the past as A's or

B's...since that is a significant source of pilots for civilian birds....

additionally, many of the heavy medical transport units (the critical care

units on wheels with hot and cold running residents, etc) use B's as

drivers...

Quite a few Level III and at least some Level II and I trauma units have

their Nurse's Aides trained to the B level...

and good docs, nurses and medics in those kinds of systems will listen when

their B tugs on their sleeve and says, " I'm not sure but I think something

has been missed. "

As a medical student and intern, I learned that there were times where I,

having to stand back and observe, noticed a problem before the rest of the

team did....I soon learned that asking an apparently 'dumb' question, while

occasionally bringing heat from the attending, often resulted in a better

result for the patient, and ultimately got me some jujubees...like the time

the 4th year resident had to go upstairs and write her own off service

notes while the junior resident (me) got to leave a day early for

vacation...the attending had noticed who had actually been doing the work to

keep the

service running.

Ultimately, the EMS system is only as good as the most observant member of

the team working on the patient at the time.

ck

In a message dated 4/3/2010 05:38:28 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 05:30, _krin135@..._

(mailto:krin135@...) said:

> and the reason it has been bastardized is that 'the basics' are all that

> EMT-Basics have to work with...so at least on occasion, the Basic sees

the

> Forest, while the Medic is stuck in the trees...even in the best of

systems.

Except that the " best " systems don't use EMT-Basics.

[Guest guest]

actually, they *are* parts of the EMS system, just specialized ones.

and for my money, the 'best' system would have a three responder team- two

medics and a basic- with at least one of the medics qualified as an FTO- if

the trip is 'only' a basic run, then one of the medics drives and the

other precepts the basic in caring for the patient.

if it's a true critical care run, then the Basic drives and the medics both

take care of the patient...

if it's somewhere in between, then the FTO decides who does what...

ck

In a message dated 4/3/2010 06:45:27 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 06:38, _krin135@..._

(mailto:krin135@...) said:

> Ultimately, the EMS system is only as good as the most observant member

of

> the team working on the patient at the time.

Absolutely! But none of the examples you just listed are EMS systems, in

the respect that we are discussing.

Rob

[Guest guest]

actually, they *are* parts of the EMS system, just specialized ones.

and for my money, the 'best' system would have a three responder team- two

medics and a basic- with at least one of the medics qualified as an FTO- if

the trip is 'only' a basic run, then one of the medics drives and the

other precepts the basic in caring for the patient.

if it's a true critical care run, then the Basic drives and the medics both

take care of the patient...

if it's somewhere in between, then the FTO decides who does what...

ck

In a message dated 4/3/2010 06:45:27 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 06:38, _krin135@..._

(mailto:krin135@...) said:

> Ultimately, the EMS system is only as good as the most observant member

of

> the team working on the patient at the time.

Absolutely! But none of the examples you just listed are EMS systems, in

the respect that we are discussing.

Rob

[Guest guest]

actually, they *are* parts of the EMS system, just specialized ones.

and for my money, the 'best' system would have a three responder team- two

medics and a basic- with at least one of the medics qualified as an FTO- if

the trip is 'only' a basic run, then one of the medics drives and the

other precepts the basic in caring for the patient.

if it's a true critical care run, then the Basic drives and the medics both

take care of the patient...

if it's somewhere in between, then the FTO decides who does what...

ck

In a message dated 4/3/2010 06:45:27 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 06:38, _krin135@..._

(mailto:krin135@...) said:

> Ultimately, the EMS system is only as good as the most observant member

of

> the team working on the patient at the time.

Absolutely! But none of the examples you just listed are EMS systems, in

the respect that we are discussing.

Rob

[Guest guest]

On Friday, April 2, 2010 10:45, " Grayson " Grayson902@...> said:

> And EMTs can't ventilate and manage an airway?

Some can, and some cannot. You've been around long enough to know that. I've

seen as many failures as I have successes. But that's not even the point. The

point is that it is not advisable to simply " manage " their airway when the

possibility of actually managing the cause of their distress with ALS care

exists.

> Don't look now, Rob, but your anti-EMT bias is showing.

And so is yours, every time you choose to take control of patient care instead

of leaving it to an EMT. Think about it.

Rob

[Guest guest]

On Friday, April 2, 2010 10:45, " Grayson " Grayson902@...> said:

> And EMTs can't ventilate and manage an airway?

Some can, and some cannot. You've been around long enough to know that. I've

seen as many failures as I have successes. But that's not even the point. The

point is that it is not advisable to simply " manage " their airway when the

possibility of actually managing the cause of their distress with ALS care

exists.

> Don't look now, Rob, but your anti-EMT bias is showing.

And so is yours, every time you choose to take control of patient care instead

of leaving it to an EMT. Think about it.

Rob

[Guest guest]

On Friday, April 2, 2010 10:45, " Grayson " Grayson902@...> said:

> And EMTs can't ventilate and manage an airway?

Some can, and some cannot. You've been around long enough to know that. I've

seen as many failures as I have successes. But that's not even the point. The

point is that it is not advisable to simply " manage " their airway when the

possibility of actually managing the cause of their distress with ALS care

exists.

> Don't look now, Rob, but your anti-EMT bias is showing.

And so is yours, every time you choose to take control of patient care instead

of leaving it to an EMT. Think about it.

Rob

[Guest guest]

On Friday, April 2, 2010 10:56, krin135@... said:

> Paramedics may save lives, but Basics save paramedics.

Yeah, and cops save lives, but meter maids save cops.

Puhleeze... that platitude is so wore out.

Rob

[Guest guest]

On Friday, April 2, 2010 10:56, krin135@... said:

> Paramedics may save lives, but Basics save paramedics.

Yeah, and cops save lives, but meter maids save cops.

Puhleeze... that platitude is so wore out.

Rob

[Guest guest]

On Friday, April 2, 2010 10:56, krin135@... said:

> Paramedics may save lives, but Basics save paramedics.

Yeah, and cops save lives, but meter maids save cops.

Puhleeze... that platitude is so wore out.

Rob

[Guest guest]

On Saturday, April 3, 2010 04:03, krin135@... said:

> it may be, but in the last 30 years, I have seen more Paramedics who have

> either forgotten the basic techniques or forgotten how to apply them than I

> like to think about.

>

> Kind of like doctors and nurses in mass casualty situations who get tied up

> dealing with one patient when they need to be supervising the care of

> many...

Absolutely. Deficiencies exist at all levels of human endeavour, from seasoned,

Board Certified practitioners to the greenest First Responder. But all other

things being equal, do you not want the highest level of education working on

your medical emergency when possible? If not, then why do EMTs turn patients

over to medics? Why do medics turn patients over to physicians? Why do

physicians punt to a specialist? That's just how the system works. I didn't

invent any of this. It's nothing new. But because we are so worried about

offending anyone's delicate ego, we simply refuse to discuss it. And patients

die because of it.

If your EMTs are saving your paramedics, your paramedics suck, and your system

needs some serious work.

Rob

[Guest guest]

On Saturday, April 3, 2010 04:03, krin135@... said:

> it may be, but in the last 30 years, I have seen more Paramedics who have

> either forgotten the basic techniques or forgotten how to apply them than I

> like to think about.

>

> Kind of like doctors and nurses in mass casualty situations who get tied up

> dealing with one patient when they need to be supervising the care of

> many...

Absolutely. Deficiencies exist at all levels of human endeavour, from seasoned,

Board Certified practitioners to the greenest First Responder. But all other

things being equal, do you not want the highest level of education working on

your medical emergency when possible? If not, then why do EMTs turn patients

over to medics? Why do medics turn patients over to physicians? Why do

physicians punt to a specialist? That's just how the system works. I didn't

invent any of this. It's nothing new. But because we are so worried about

offending anyone's delicate ego, we simply refuse to discuss it. And patients

die because of it.

If your EMTs are saving your paramedics, your paramedics suck, and your system

needs some serious work.

Rob

[Guest guest]

On Saturday, April 3, 2010 04:03, krin135@... said:

> it may be, but in the last 30 years, I have seen more Paramedics who have

> either forgotten the basic techniques or forgotten how to apply them than I

> like to think about.

>

> Kind of like doctors and nurses in mass casualty situations who get tied up

> dealing with one patient when they need to be supervising the care of

> many...

Absolutely. Deficiencies exist at all levels of human endeavour, from seasoned,

Board Certified practitioners to the greenest First Responder. But all other

things being equal, do you not want the highest level of education working on

your medical emergency when possible? If not, then why do EMTs turn patients

over to medics? Why do medics turn patients over to physicians? Why do

physicians punt to a specialist? That's just how the system works. I didn't

invent any of this. It's nothing new. But because we are so worried about

offending anyone's delicate ego, we simply refuse to discuss it. And patients

die because of it.

If your EMTs are saving your paramedics, your paramedics suck, and your system

needs some serious work.

Rob

[Guest guest]

you will note that I didn't make any case for the practicality of said

system, nor the dilution of Medic experience that it implies.

I also don't agree with the SAMU concept, where a doc rides along on every

call...there are some docs who are comfortable in the field and able to

work there, but most of them, even in a SAMU system, are probably going to

have trouble with the idea of a high flow Diesel bolus.

ck

In a message dated 4/3/2010 08:23:46 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 07:09, _krin135@..._

(mailto:krin135@...) said:

> and for my money, the 'best' system would have a three responder team-

two

> medics and a basic- with at least one of the medics qualified as an FTO-

if

> the trip is 'only' a basic run, then one of the medics drives and the

> other precepts the basic in caring for the patient.

Now you're talking my language!

Rob

[Guest guest]

you will note that I didn't make any case for the practicality of said

system, nor the dilution of Medic experience that it implies.

I also don't agree with the SAMU concept, where a doc rides along on every

call...there are some docs who are comfortable in the field and able to

work there, but most of them, even in a SAMU system, are probably going to

have trouble with the idea of a high flow Diesel bolus.

ck

In a message dated 4/3/2010 08:23:46 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 07:09, _krin135@..._

(mailto:krin135@...) said:

> and for my money, the 'best' system would have a three responder team-

two

> medics and a basic- with at least one of the medics qualified as an FTO-

if

> the trip is 'only' a basic run, then one of the medics drives and the

> other precepts the basic in caring for the patient.

Now you're talking my language!

Rob

[Guest guest]

you will note that I didn't make any case for the practicality of said

system, nor the dilution of Medic experience that it implies.

I also don't agree with the SAMU concept, where a doc rides along on every

call...there are some docs who are comfortable in the field and able to

work there, but most of them, even in a SAMU system, are probably going to

have trouble with the idea of a high flow Diesel bolus.

ck

In a message dated 4/3/2010 08:23:46 Central Daylight Time,

rob.davis@... writes:

On Saturday, April 3, 2010 07:09, _krin135@..._

(mailto:krin135@...) said:

> and for my money, the 'best' system would have a three responder team-

two

> medics and a basic- with at least one of the medics qualified as an FTO-

if

> the trip is 'only' a basic run, then one of the medics drives and the

> other precepts the basic in caring for the patient.

Now you're talking my language!

Rob

[Guest guest]

Ah! Well now this is something we certainly agree upon. The so-called " basics "

are indeed the foundation of medical practice at all levels. Yes, they do get

overlooked in the heat of the moment, and again, by practitioners at all levels.

In that respect, " the basics " save us all, and hopefully our patients too. But

all too often the concept is bastardised to mean EMT-Basics, not " the basics " ,

and that is the point I contend.

Rob

On Saturday, April 3, 2010 04:33, krin135@... said:

> ah...then you are misunderstanding the meaning of the platitude by taking

> it at apparent face value.

>

> One of the things repeatedly emphasized in ACLS and ATLS (as much as I

> despise the merit badge approach to medical education) is that if the patient

> is NOT getting better, go back to basics and reevaluate your patients from

> the ABCs.

>

> These are the basics that save paramedics (and doctors and nurses)-

> remembering and applying basic principles to every patient who is not

responding

> as expected.

>

> Things like appropriate air movement as the gold standard of ventilation;

> that leaks need to be plugged before fluids are poured in, so " don't pop

> the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis does

> not mean pain/panic relief; a very gravid patient should not be laying flat

> on her back; and that the best antibiotic is often the hand washing and hand

> sanitizing done before touching the patient (including sanitizing your

> stethescope).

>

> ck

[Guest guest]

Ah! Well now this is something we certainly agree upon. The so-called " basics "

are indeed the foundation of medical practice at all levels. Yes, they do get

overlooked in the heat of the moment, and again, by practitioners at all levels.

In that respect, " the basics " save us all, and hopefully our patients too. But

all too often the concept is bastardised to mean EMT-Basics, not " the basics " ,

and that is the point I contend.

Rob

On Saturday, April 3, 2010 04:33, krin135@... said:

> ah...then you are misunderstanding the meaning of the platitude by taking

> it at apparent face value.

>

> One of the things repeatedly emphasized in ACLS and ATLS (as much as I

> despise the merit badge approach to medical education) is that if the patient

> is NOT getting better, go back to basics and reevaluate your patients from

> the ABCs.

>

> These are the basics that save paramedics (and doctors and nurses)-

> remembering and applying basic principles to every patient who is not

responding

> as expected.

>

> Things like appropriate air movement as the gold standard of ventilation;

> that leaks need to be plugged before fluids are poured in, so " don't pop

> the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis does

> not mean pain/panic relief; a very gravid patient should not be laying flat

> on her back; and that the best antibiotic is often the hand washing and hand

> sanitizing done before touching the patient (including sanitizing your

> stethescope).

>

> ck

[Guest guest]

Ah! Well now this is something we certainly agree upon. The so-called " basics "

are indeed the foundation of medical practice at all levels. Yes, they do get

overlooked in the heat of the moment, and again, by practitioners at all levels.

In that respect, " the basics " save us all, and hopefully our patients too. But

all too often the concept is bastardised to mean EMT-Basics, not " the basics " ,

and that is the point I contend.

Rob

On Saturday, April 3, 2010 04:33, krin135@... said:

> ah...then you are misunderstanding the meaning of the platitude by taking

> it at apparent face value.

>

> One of the things repeatedly emphasized in ACLS and ATLS (as much as I

> despise the merit badge approach to medical education) is that if the patient

> is NOT getting better, go back to basics and reevaluate your patients from

> the ABCs.

>

> These are the basics that save paramedics (and doctors and nurses)-

> remembering and applying basic principles to every patient who is not

responding

> as expected.

>

> Things like appropriate air movement as the gold standard of ventilation;

> that leaks need to be plugged before fluids are poured in, so " don't pop

> the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis does

> not mean pain/panic relief; a very gravid patient should not be laying flat

> on her back; and that the best antibiotic is often the hand washing and hand

> sanitizing done before touching the patient (including sanitizing your

> stethescope).

>

> ck